Article
Assisted dying
Care
Creed
Death & life
5 min read

“Shortening death” sidesteps the real battle

We need to do more than protest bad deaths, we need to protest death itself, it's more than biological.

Tom has a PhD in Theology and works as a hospital physician.

A hand drapes over the side of an object out of shot.
Michael Schaffler on Unsplash.

What is “death”? It’s surprising the term has received little attention in the assisted dying discussion so far, because more hangs on the answer than one might expect. At a press briefing, Kim Leadbeater MP stated that the assisted dying bill she is proposing is about “shortening death, not ending life.” 

But what meaning does “death” have here? 

The current bill defines neither “death” nor “dying.” Granted, it implies a biological definition. The bill speaks of administering approved substances to “cause that person’s death” and of capacity and decision-making around “ending life.” These fit the understanding of death with which the medical profession operates—death is the point in time when the combined functions required for human life cease. It is a one-time event, the end of physiology, and so is recognised by a combination of physical signs.  

Death, then, is a diagnosis. 

So, too, “dying”—though here the waters are murkier. Setting aside sudden deaths, medical talk of dying takes us out of binary territory. Dying speaks of a process, of the “terminal phase.” Within medicine a diagnosis of dying heralds the expectation that a person’s death will occur within hours or days. And so, the focus shifts. The task of care is no longer the coordinated work of investigation, preserving life, and treating symptoms. Now attention is on bringing relief to the process of dying. 

The bill seems wise to much of this. Though definitions of death and dying are absent, the bill does define terminal illness—“an inevitably progressive condition which cannot be reversed by treatment” and from which the event of death “can reasonably be expected within 6 months.” And so, it clearly distinguishes terminal illness from biological death and, implicitly, from dying. 

Of course, terminal illness and biological death are related. Terminal illness is irreversible, and where terminal illness leads is death. Or, you might say, it leads to the end of life. Apart from the timescale of six months, the same may be said of ageing: ageing is irreversible, and where ageing leads is death. This is why Kim Leadbeater’s comment was puzzling to me. I suspect what she really meant was “shortening terminal illness.” If so, this is confusing because, within the framework of the bill, “shortening terminal illness” and “ending life” are identical. It seems she was getting at something else.

“It seems odd that in the name of eliminating suffering, we eliminate the sufferer.” 

Stanley Hauerwas

I suspect Kim Leadbeater was echoing a conviction at home in the Christian faith. That is, try as we might to keep death at a distance and restrict it to a faraway frontier, the life of human beings involves death. I don’t simply mean the biological death we witness—the deaths of friends, relatives, or even strangers. I mean death intrudes upon the way we experience life. Death is more than simply biological. 

The fear of death belongs in this category. For some, the impending loss of relationships and joys casts a shadow over life, giving birth to apprehension. Death is not simply a factual matter but something that exerts power and influence. Or take disease and illness. Built into the notion of terminal illness is the idea that the sickness borne by a human body will ultimately bring about that body’s death. That body already speaks of its death. Death is making itself felt in advance. 

And so, death is more than a biological event. Even living things can bear the marks of death. 

This is no novel claim. The creation account recorded in the Bible says that in the beginning, there was good. But an intruder appears. In the wake of humanity’s choice to go its own way rather than the way of its Maker, death arrives on the scene. And death is an imposter—not simply a physiological fact at the end of the road, but a destructive and alien presence in God’s good world. 

Understood in this way, death is not something that God intends humans simply submit to. Death is something to protest. This is why Kim Leadbeater’s comment gets at something important: this kind of death should be protested. The marks of death should not be accommodated, because they do not belong to the goodness of what God has made. 

At the heart of the Christian faith is God’s own ultimate protest against the force of death. Christians celebrate that God himself came in the man Jesus to “destroy death.” This is plainly more than biological. Jesus came to free humanity from the entirety of death’s grip. Hence why, when Jesus speaks of “eternal life” he means more than endless biological existence. He means liberation from all the havoc that death brings to bear within God’s world. To the Christian imagination, the power of death must be protested because God protested it first. 

The question is how to protest death. Within the framework of the bill, shortening death or terminal illness is identical with ending life. This is the only form protesting death can take. 

But the Christian faith makes a far more radical claim: God alone overcame death by dying. This is the point: Jesus was the one—the only one—who emerged resurrected victor in the contest with the power of death. In seeing his death and resurrection, an unshakeable hope emerges. Death is not the victor. And this hope stands above our present experience of death—in whatever form—and, at the same time, calls us to join the protest. 

Ethicist Stanley Hauerwas once wrote: “it seems odd that in the name of eliminating suffering, we eliminate the sufferer.” I have deliberately avoided discussing suffering, not least because it would take me too far afield. Yet Hauerwas has put his finger on what I’m getting at. Protesting death—in the big sense—belongs to the Christian faith. Protesting suffering and pain, economic and racial injustice, fractured relationships and broken societies, are all part of this protest. But can eliminating those who live within the shadow of death be part of this protest? I think not. The Christian faith believes there is only one who can overcome death in this way, and that is God himself—who has already done it.

Article
Care
Culture
Mental Health
Trauma
5 min read

Stillness is not always peace: how wellness and illness intertwine in silence

Stillness invites clinical insight—and a deeper kind of presence

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

A seated Celine Dion, leans forward, head to the side, holding a mic.
Celine Dion, stiff-person syndrome sufferer.
Celine Dion.

The Global Wellness Institute defines wellness as the active pursuit of activities, choices and lifestyles that lead to a state of holistic health. It includes rest and rejuvenation, through mindfulness, meditation and sleep. As a care home nurse, I am intrigued by the subject of stillness – for patient and nurse - in the pursuit of wellness, and as a sign of illness.  

There’s a lot of stillness in illness - from the dense paralysis that can follow stroke or spinal cord injury, to the subtle weakness or stiffness in an arm that might signal the onset of motor neurone disease. Over half of people with Parkinson’s experience ‘freezing’, feeling as if their feet are momentarily glued to the ground. Freezing is also a feature of stiff-person syndrome – the auto-immune neurological condition powerfully documented by Celine Dion in her film I Am. In so-called stone-man syndrome, muscle tissue is replaced by bone, an immobile ‘second skeleton’. 

The stillest still is seen in death itself. I’ve stood still with spouses and sons as their loved ones breathe their last. Alone, I’ve watched the hush between heartbeats until there exists only stillness beside sorrow. It’s a stillness like no other, when breath becomes still air, and the only movement is through a window opened to let air in, and souls out, in time-honoured nursing tradition. 

In memory of babies born still, a public education and awareness campaign has been launched in the US. “Stillness is an illness” calls for families and healthcare providers to take seriously altered foetal movement in pregnancy, which is reported by 50 per cent of mothers who experience stillbirth. Stillbirth is a tragedy insufficiently addressed in global agendas, policies, and funded programmes, according to the World Health Organization. Mothers in sub-Saharan Africa and Southern Asia are at highest risk, with nearly 1.5 million stillbirths in these regions in 2021. 

Sometimes stillness manifests in more muted ways. When dementia robs the recall of person, place and time, residents no longer lift their head in response to their name, nor appear at their chosen place at the breakfast table in the morning. Television presenter Fiona Phillips describes the late stages of dementia for her mother, when she “spent whole chunks of time just sitting and staring ahead, only able to give out a series of sounds.” In care home nursing, I have brought stillness to an agitated mind. Therapeutic touch has relieved tension; creative activities have reduced restless pacing up and down. Music, movement, and medication can also calm a troubled mind. 

In the further pursuit of patient wellness, the nurse may need to be still. The “CAREFUL” observation tool has been developed in nursing homes, in which the nurse sits still and discreetly watches a resident for a period of time, assessing their activities and interactions, working out what brings wellbeing, or ill-being, for that individual; residents in this case being our best teachers. Other times in dementia care, the nurse is still as they patiently wait for a resident to explore, enquiring into self-made mysteries solvable only by themselves, examining everything from door handles to another resident’s buttons; or to slowly finish a meal, their swallow also affected by the disease.  

Punctuating any frantic nursing shift are other moments of necessary stillness as the nurse performs intricate procedures, carefully inserting catheters, delicately taking blood from fragile veins, or applying prolonged pressure to stem bleeding caused by a catheter during cardiac stenting. In the operating theatre, the scrub nurse stands still awaiting a surgeon’s call; the “honor walk” or walk of respect is a ceremonial procession in which healthcare staff line the corridor, in silent tribute, as a brain-dead patient is taken to theatre for organ donation. 

There’s a different stillness sought in nursing, and elsewhere, which runs very deep. Described by missionary and author Elisabeth Elliot as a “perfect stillness…a great gift”, it is, in her words, “not superficial, a mere absence of fidgeting or talking.  It is a deliberate and quiet attentiveness—receptive, alert, ready”. It’s an expectant stillness in which we “put ourselves firmly and determinedly in God’s presence, saying ‘I’m here, Lord.  I’m listening’.” Writing for the Christian Medical Fellowship, nurse Sherin describes such a seeking during a stressful shift. “Overwhelmed, I stepped away to find a quiet place. I ended up in a washroom. It wasn’t ideal, but there I cried out to God, asking for courage, peace, patience, and above all, love for that patient.” And her prayer was answered. “That, to me, was the quiet, powerful presence of Christ,” she writes. 

Her role model was Jesus himself who often stepped away to be still, to seek spiritual sustenance. Just before he fed the five thousand, Jesus said to his tired and hungry disciples, “Come with me by yourselves to a quiet place and get some rest.” When grieving the execution of John the Baptist, he withdrew by boat privately to a solitary place; and in the hours before his arrest, Jesus withdrew about a stone’s throw from his disciples, knelt down and prayed. An angel from heaven appeared to him, and strengthened him. We too are invited, in the book of Psalms, to “Be still and know God” when hard pressed and weary. Here, the words “be still” derive from the Hebrew rapha which means “to be weak, to let go, to release”, or simply to surrender. It’s a theme repeated in many of the great Christian hymns, hinting at an expectant, sustaining stillness, invoking God’s promise of His presence in that stillness. Little-known hymnwriter Katharina von Schlegel, writing in the eighteenth century, captures it perfectly. 

Be still, my soul! the Lord is on your side; 
Bear patiently the cross of grief or pain; 
Leave to your God to order and provide; 
In ev'ry change he faithful will remain. 
Be still, my soul! your best, your heav’nly friend 
Thru' thorny ways leads to a joyful end. 

I’ve sought this stillness, and it’s brought me wellness. It’s the reason why, despite some difficult days, I am a nurse. Still. 

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